Provider Demographics
NPI:1073639282
Name:SAYAKHOT, SOYPHET (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:SOYPHET
Middle Name:
Last Name:SAYAKHOT
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W OLYMPIC BLVD
Mailing Address - Street 2:#550
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1400
Mailing Address - Country:US
Mailing Address - Phone:213-553-1850
Mailing Address - Fax:213-553-1864
Practice Address - Street 1:605 W OLYMPIC BLVD STE 550
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1474
Practice Address - Country:US
Practice Address - Phone:213-553-1850
Practice Address - Fax:213-553-1864
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator